The closure of clinics in Texas was already a problem years before HB 2 passed. Amy Hagstrom Miller, who owns Whole Woman's Health, the lead plaintiff in the Supreme Court case, told Mother Jones she remembers a time prior to 2008 when the passage of abortion restrictions became a regular feature in the state Legislature. Then there were between 60 and 70 clinics throughout the state. By 2013 there were 40, and the law shuttered more than half of them. When the Supreme Court got involved, only 19 clinics remained open, and there was a massive swath from San Antonio to El Paso without a single clinic. Many Texas women who needed abortions went to neighboring New Mexico.

Two Whole Women's Health clinics were forced to close after Gov. Rick Perry signed HB 2 into law three years ago, and the admitting privileges requirement reduced the number of physicians on their staff. Hagstrom Miller had filed away spreadsheets detailing a contingency plan in case the ruling didn't go her way. "It's different to have to throw those spreadsheets away--I kind of wanted to have a ritual burning." 

In April 2014, Reproductive Services of El Paso--one of the other plaintiffs in the Supreme Court case--shuttered after its physician lost her admitting privileges at a local hospital, meaning the clinic was no longer in compliance with HB 2. Last September, the clinic, which has historically served 2,000 patients every year, reopened at a new location after a federal judge blocked the admitting-privileges provision from being enforced pending the Supreme Court decision.

But before opening its doors, Reproductive Services still had to take the Texas Department of Health and Human Services to court over a licensing disagreement involving whether the clinic had to adhere to the surgical center standards that had recently been put on hold in federal court. The judge threatened to hold the state health department in contempt for insisting the clinic adhere to the standards that weren't supposed to be enforced and for not issuing the license. Aside from the cost of litigation, Hagstrom Miller said the clinic has had an inspection every three months since it opened.

Opening a new clinic in Texas takes a lot of money, resources, and patience. A license can cost a provider more than $5,000, a nonrefundable fee. Heather Busby, executive director at NARAL Pro-Choice Texas, explains there are a series of inspections that each clinic must undergo before opening, but staff members have to be hired and equipment has to be installed to meet the requirements to obtain licensure. "It's not like you get licensed and then you staff up and buy equipment," she says, "you have to do all those things first."

Another threat for providers has been the Texas Department of Health and Human Services, which has evolved, Hagstrom Miller said, to become a "more political, gotcha endeavor." Four days after the Supreme Court ruling, officials at the state Department of Health and Human Services published a proposal in the Texas Register that would require providers to cremate or bury fetal remains, regardless of gestational stage. The final rules are expected to take effect in September, and Gov. Abbott has expressed approval at the update.

Bryan Black, a spokesman for the health commission, told Mother Jones that the rules aren't a major change, and that they only seek to eliminate a very specific form of tissue disposal. He said the incineration method most commonly used is appropriate under the code. Black also said it was Abbott's office that requested that the agency look into creating an amendment back in January. Arkansas, Indiana, and Georgia have similar laws on the books. Ohio, South Carolina, and Mississippi have all considered requirements to this effect as well.